Healthcare Provider Details

I. General information

NPI: 1487412003
Provider Name (Legal Business Name): REBECCA HULL AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 VETERANS BLVD
DENHAM SPRINGS LA
70726-4722
US

IV. Provider business mailing address

31864 LINDER RD
DENHAM SPRINGS LA
70726-1516
US

V. Phone/Fax

Practice location:
  • Phone: 225-667-5110
  • Fax: 833-357-1731
Mailing address:
  • Phone: 225-278-8286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number234599
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number234599
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: